Knock Knock, Hi! with the Glaucomfleckens

Latest Episodes:

Knock Knock Eye: Federal Student Loan Caps and the Future of Medical School Access Nov 05, 2026

Show notes

I’m just back from receiving an early career achievement award at the University of Iowa. The hard conversation while I was there was about pediatric ophthalmology, which is in trouble. There are only 15 fellows across the entire country this year. I get into the hidden curriculum that pushes residents away from pediatrics, why practices quietly turn pediatric fellowship grads into comprehensive ophthalmologists, and the new revenue-silo model we’re building at my practice to let pediatric ophthalmologists actually do their job.
Then med school tuition. Starting this past summer, federal loans are capped at $50K/year and $200K total, which is well below the $297K median cost of a public med school. I don’t think this forces tuition down. I think it pushes applicants toward private loans or filters admissions toward wealthier students. The AMA opposes the cap, but their framing bothers me. The conversation should be about why tuition is this high in the first place, not just preserving the ability to borrow against it.

Takeaways:

Only 15 pediatric ophthalmology fellows matched in the entire U.S. this year, leaving the vast majority of academic ophthalmology programs without a fellow.
A hidden curricular bias framing pediatrics as “easy” continues to steer residents away from pediatric ophthalmology, even those who entered training interested in it.
Will’s practice is piloting a dedicated pediatric ophthalmology revenue silo with purpose-built pediatric lanes to prove that pediatric ophthalmologists don’t need to be subsidized or turned into comprehensive ophthalmologists.
The new federal student loan caps ($50K/year, $200K total) leave a nearly $100K gap below the $297K median public med school cost and are unlikely to force tuition down.
Student loan burden shapes specialty choice and continues to drive primary care and pediatric shortages.

—

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What Medicine Gets Wrong About Disability with Ashira Greenberg & Shauna Ikahihifo Nov 03, 2026

Show notes

I failed my very first standardized patient encounter in medical school because I saw a 49-year-old woman with abdominal pain and did not order a pregnancy test — immediate fail, well-earned shame, lesson learned — and it turns out that story is actually a pretty good entry point to this episode about what standardized patient education is, what it's missing, and what Ashira Greenberg and Shauna Ikahihifo are doing to fix it. Ashira is a full-time mobility device user and disability advocate who grew up loving hospitals because, as her kid brain correctly reasoned, hospitals are built for people on wheels; Shauna is an autistic woman who was diagnosed at 33 after an 11-year diagnostic odyssey in which she lost the ability to speak for weeks during a burnout episode and was told it was just the worst anxiety her doctors had ever seen. They're co-founders of the disability Special Interest Group within the Association of Standardized Patient Educators (ASPE), and their Lived Experience Project is specifically about getting neurodivergent and disabled standardized patients into medical training encounters so students hear actual feedback from people who know what it feels like to be on that side of the room — because 42% of medical schools have zero disability content in their curriculum, 80% of physicians don't believe their disabled patients have a good quality of life, 1 in 4 disabled people has no regular PCP, and putting a medical student in a wheelchair for an afternoon and calling it disability education is not the answer. The further I get into my career, the more I believe communication is at least as important as diagnosis, and this conversation made that feel more true than ever.

Takeaways:

Pain scales are almost unusable for many neurodivergent patients
80% of physicians don't believe disabled patients have a good quality of life
The social model of disability reframes the question
Simulating disability is not the same as understanding it
1 in 4 disabled people has no regular primary care physician

—

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Knock Knock Eye: Over-the-Counter Redness Relievers: An Ophthalmologist’s Guide Oct 29, 2026

Show notes

Halloween is around the corner, so here is a little housekeeping. I open with the saga of my HOA fining me for window units during a 117°F Portland heat wave, including the time I taped a photo of Brad Pitt to one to make it “more beautiful.” Then our family’s Star Wars Halloween plan: I was going to hide inside an inflatable Jabba the Hutt until Kristin called me on it, so I’m compromising with a Jawa.

After the break, the real news. The FDA just approved Brightly (Alcon’s apraclonidine 0.125%), the newest over-the-counter redness reliever. I walk through why Visine is the worst thing ever invented, why Lumify is still my go-to recommendation if you absolutely must use one, and why I’m cautious about Brightly, especially around kids. And a reminder: if your eye redness comes with any other symptom, don’t mask it. Go see an eye doctor.

Takeaways:

Visine’s tetrahydrozoline is a potent vasoconstrictor that causes rebound redness and chronic irritation, and ingesting it can cause life-threatening cardiovascular effects.
Lumify (brimonidine 0.025%) has been the preferred over-the-counter option since 2017, but overuse can trigger allergic reactions that force patients to stop.
Brightly (apraclonidine 0.125%), approved October 16, 2026, is Alcon’s new low-dose alpha agonist redness reliever indicated for ages 12 and up.
Will remains cautious about Brightly for pediatric exposure risks, since full-dose apraclonidine can cause CNS depression in children.
Age-related eye redness without associated symptoms generally doesn’t need treatment, but redness with burning, discharge, blurry vision, or light sensitivity should be evaluated by an eye doctor.

—

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If you want more information on models I use:

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What Medicine Gets Wrong About Pain with Dr. Rachel Zoffness Oct 27, 2026

Show notes

Dr. Rachel Zoffness is a pain psychologist and assistant clinical professor at UCSF and Stanford, and she came on to do something I desperately needed, explain what I actually did not learn in medical school about pain, which turns out to be most of it. The thing I absorbed is apparently what 96% of medical schools teach as their entire compulsory pain curriculum, and it's missing about two-thirds of the actual story because pain is not made in your skin, it's constructed by your brain, which means it is always biopsychosocial: biological inputs, psychological inputs, and social inputs, and you cannot treat chronic pain by ignoring any of them.

We go through the tale of two nails, why Usain Bolt's S-curved spine and unequal leg length are a really compelling argument against doing back surgery before you've exhausted every other option, how loneliness chemically amplifies pain the way social connection suppresses it, what central sensitization actually is and why chronic pain patients are not imagining anything, and how "pain as the fifth vital sign" was literally a big pharma campaign to sell OxyContin that caused enormous damage to how medicine prescribes opioids. Kristin also gets a professional consult on being a Highly Sensitive Person, which Rachel frames as being a more accurate seismograph than other people.

Takeaways:

A nociceptor is not a pain receptor
The "tale of two nails" proves that hurt and harm are not the same thing
Chronic pain is a disease of the central nervous system
Loneliness is a direct pain amplifier
"Pain is the fifth vital sign" was a big pharma invention

—

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The Zoffness Team

Pain Science and Education

Tell Me Where It Hurts

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Knock Knock Eye: Breaking down the American Diabetes Association Boycott Oct 22, 2026

Show notes

This week I get into the No Surprises Act, starting with my own $20,000 out-of-network bill after my cardiac arrest and the nine-month fight to resolve it. The law was supposed to prevent exactly that, and from the patient side it works. But the arbitration system behind it is now processing millions of claims per year (not the 22,000 the feds expected), doctors are winning about 85% of the time, and insurance companies are lobbying hard to rewrite the rules.

Then the drama at the American Diabetes Association. The ADA published an editorial in Diabetes Care criticizing proposed NIH cuts, then invited NIH head Jay Bhattacharya to keynote their June meeting. Twelve members handed out reprints of that same editorial outside the keynote, five got escorted out by Louisiana State Police, and Dr. Khan was denied re-entry to his own panel. A CEO apology video, blocked editorials, and a growing boycott later, we’re watching a case study in physician collective advocacy.

Takeaways:

Will’s own $20,000 surprise bill after his cardiac arrest came from out-of-network physicians inside an in-network hospital, and took nine months of fighting to resolve.
The No Surprises Act’s arbitration system was projected to handle 22,000 claims per year but now handles millions, with physicians winning roughly 85% of disputes.
Insurance companies are lobbying for amendments to the arbitration system and routinely delay payment of settled claims by six to nine months to continue floating the money.
The American Diabetes Association had five members escorted out by Louisiana State Police in June for handing out reprints of an editorial published in the ADA’s own journal criticizing NIH funding cuts.
A growing boycott of the ADA journal Diabetes Care illustrates the increasing willingness of physicians and researchers to use collective action against their own professional organizations.

—

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What the 19th Century Teaches Us About Medicine Right Now with Dr. Lindsey Fitzharris Oct 20, 2026

Show notes

Dr. Lindsey Fitzharris is back and she brought her best book yet. Sleuth Hound: The Case of the Real Sherlock Holmes, out October 20th, which tells the story of Joseph Bell, the Edinburgh surgeon who was the actual inspiration for Sherlock Holmes.

We cover optography (the Victorian belief that eyeballs record the last thing a person sees before death, which murderers took seriously enough to destroy their victims' eyeballs), Bell's diagnostic party tricks (dipping his middle finger in a flask and tasting his index finger while students drank whatever was in it), how the Chantereau poisoning case connects to Robert Louis Stevenson and Dr. Jekyll and Mr. Hyde, why much of 19th century forensics was built on the brutalized bodies of women killed by their husbands, and the extraordinary case where Bell and Conan Doyle defended a man they personally believed was guilty because the body had been embalmed before autopsy and the physical evidence was compromised, which Lindsey correctly identifies as the "if the glove doesn't fit" moment of the 1890s.

Takeaways:

Joseph Bell worked as an actual consulting detective
Victorian forensics advanced largely on the bodies of women killed by their husbands
Optography was a real and widely believed forensic theory
Bell and Conan Doyle once defended a man they believed was guilty
The death of the physical exam has a 150-year precedent

—

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To learn more about Microsoft Dragon Copilot, visit:

⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠

Go to ⁠cozyearth.com⁠, and use code KnockKnock, for up to 20% off home and sleepwear. And when they ask where you heard about them at checkout, let them know you heard about them right here on Knock Knock, Hi!

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Knock Knock Eye: Why This Nobel Prize Could Change How We Treat Blindness Oct 15, 2026

Show notes

The weight of the healthcare system has been sitting heavy. Our practice officially dropped UnitedHealthcare after they offered a 0.8% rate increase, and I’m feeling genuine empathy fatigue for the first time since I came back to clinic after my cardiac arrest. I talk about what that feeling actually is, how to spot it, and what finally helped me through it last time. Also, Dr. Oz is pushing to eliminate modifier 25, which would effectively end same-day procedures in private practice.
Then some actual good news: the 2026 Nobel Prize in Physiology or Medicine went to Peter Hegemann, George Nagel, and Karl Deisseroth for optogenetics. I walk through the 2021 Nature Medicine case of a man with 40 years of retinitis pigmentosa who regained the ability to locate and touch objects after an AAV-delivered opsin was injected into his retinal ganglion cells. It’s mutation-agnostic, it’s low-resolution, and it’s one of the most exciting developments in vision science in a long time.

Takeaways:

After years of negotiation, Will’s practice has fully dropped UnitedHealthcare over a 0.8% rate increase offer against a 3% request.
Empathy fatigue is real, often follows personal medical trauma, and requires time off, honest conversations, and self-awareness to work through.
Dr. Oz and CMS are pushing to eliminate modifier 25, which would effectively end same-day E&M visits combined with procedures and devastate private practice.
The 2026 Nobel Prize in Physiology or Medicine went to the discoverers and developers of optogenetics, which has already shown promise restoring partial vision in retinitis pigmentosa.
Optogenetics is mutation-agnostic because it installs light sensitivity in surviving ganglion and bipolar cells rather than repairing dead photoreceptors.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

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If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

To learn more about Microsoft Dragon Copilot, visit:

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Glauc Talk: When AI Claims Credit for Human Research Oct 13, 2026

Show notes

We did back-to-school night for our ninth grader and I came away wanting to re-enroll myself. The CS teacher (28 years in the classroom) convinced me that what computer programming really teaches is attention to detail, one misplaced space breaks the whole thing, and the Spanish teacher, who grew up under Franco with his left hand literally tied to his chair for writing right-handed, had a philosophy so good I almost asked if I could come on Monday. After the break, I get into the AI mathematics controversy. OpenAI announced their agents solved the Navier-Stokes equations using 10,000 agents over 88 hours on a problem humans have worked on for 60 years, but an NYU mathematician and an Anthropic researcher claim OpenAI trained on their ongoing unpublished work without attribution, which is a more acute version of the IP argument that's followed AI from the start, and it bugs me in a way I don't have a clean answer for.

Takeaways:

Computer programming teaches attention to detail above almost everything else
OpenAI's Navier-Stokes announcement is a sharper version of AI's ongoing IP problem
The AI regulation debate keeps hitting the same wall
Franco's Spain was still enforcing Catholic baptism within 72 hours of birth and banning left-handedness well into the 1970s
High school is wasted on teenagers

—

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

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Knock Knock Eye: Myopia Is Officially a Disease: What the AMA Reclassification Means Oct 08, 2026

Show notes

The Blue Cross Blue Shield Association put out a truly hilarious study complaining that AI tools drove nearly $1 billion in extra costs for their insurers over two years, blaming hospitals and doctors for using AI to code more accurately. This from the industry that pioneered using AI to deny claims. It's an arms race now, and the only people who actually lose are patients, premiums keep going up regardless of who wins.

Then two big eyeball wins. The AMA House of Delegates finally reclassified myopia as a disease, which should push pediatric progression treatments like Stellest lenses, ortho-K, and atropine drops onto medical insurance instead of cash pay. And Dr. Morgan Micheletti's team sent 135 intraocular lenses to the International Space Station for six months to see if cataract surgery could survive deep space travel, most held up remarkably well.

Takeaways:

Blue Cross Blue Shield Association is complaining that AI tools have driven ~$1 billion in extra insurer costs, ignoring that insurance companies pioneered using AI to deny and downcode claims.
The healthcare AI arms race is a battle for a fixed pot of money, and patients always end up paying via higher premiums.
The AMA House of Delegates has adopted a resolution formally classifying myopia as a disease, opening the door for medical insurance coverage of progression treatments.
Stellest lenses, orthokeratology, and atropine eye drops are the current options for slowing pediatric myopia progression, with Stellest showing about 70% reduction over two years.
Dr. Morgan Micheletti's ISS study found that most acrylic intraocular lenses survived six months exposed to space, suggesting cataract surgery in space may eventually be feasible.

—

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

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The Neuroscience Behind Being "Too Sensitive" (with Dr. Sasha Hamdani) Oct 06, 2026

Show notes

This week Kristin and I sat down with Dr. Sasha Hamdani, a board-certified psychiatrist, ADHD expert, and author of the new book Too Sensitive: Rejection, Resilience, and the Science of Feeling Deeply. Sasha breaks down the actual neuroscience behind why some of us feel emotions so intensely, and gave us some genuinely useful tools for dealing with it. We also got a proper medical explanation for hangxiety, which, as someone who has experienced it, I found extremely validating.

Sasha also walked us through rejection sensitive dysphoria, its connection to ADHD, and her own long and slightly chaotic road to getting diagnosed at 40. And look, I'll admit that by the end of this conversation I may have lost an ongoing argument with Kristin about whether or not I have anxiety.

Takeaways:

Emotional sensitivity has a neurological basis involving a hyper-responsive amygdala and an under-responsive prefrontal cortex.
Cyclic sighing, a specific breathing technique, can help calm the nervous system and re-engage logical thinking during moments of panic.
Rejection sensitive dysphoria is closely linked to ADHD and can be one of the most limiting aspects of the condition for many people.
"Hangxiety" occurs because alcohol interacts with GABA receptors similarly to anti-anxiety medications, leading to a rebound anxiety effect the next morning.
Delaying your response to conflict or bad news allows alarm chemicals to subside, leading to a calmer, more rational reaction.

—

Want more Sasha Hamdani, MD?

@thepsychdoctormd

To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live

We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com

Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/

If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken

If you want more information on models I use:

To learn more about Microsoft Dragon Copilot, visit:

⁠⁠http://aka.ms/knockknockhi ⁠⁠

Cozy Earth almost never does 30% off, and they're doing it right now through the 11th. Go to cozyearth.com, use code KnockKnock, and get 30% off home and sleepwear. Cozyearth.com, code KnockKnock

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